Medicaid Cuts and Work Requirements

What Is Medicaid

Medicaid is a joint federal-state health insurance program for people with low incomes. With CHIP, it covers about 73.2 million people, which makes it the largest source of health coverage in the country, and it reaches children, pregnant women, seniors, and people with disabilities. States run their own versions of it under federal rules, and the federal government pays most of the bill.

Who Qualifies for Medicaid

You qualify for Medicaid through your income and who you are. Children, pregnant women, and people on Supplemental Security Income qualify in every state. In the 40 states and D.C. that expanded, any adult under 65 with income up to 138% of the poverty level qualifies, which is $22,025 a year for one person in 2026. Apply through your state Medicaid agency or HealthCare.gov.

Income is the main test, and it is measured against the federal poverty level for your household size. In the 40 states and D.C. that expanded, the adult limit is 138% of that level, and no limit on savings applies.

The limit depends on which group you fall into.

• Children: covered in every state up to at least 133% of the poverty level, and many states go higher through Medicaid and CHIP.
• Pregnant women: covered in every state, at higher incomes than other adults.
• Adults under 65: covered up to 138% in expansion states. In the 10 states that did not expand, parents qualify only under a limit the state sets, and most adults without children cannot qualify at any income.
• People on Supplemental Security Income: a group every state must cover.
• Seniors and people with disabilities or blindness: counted under separate rules that can include a limit on savings and other assets, set by the state.

These groups come from Medicaid.gov. You can apply any time of year through your state Medicaid agency or HealthCare.gov, which sends your application to the state.

Medicare vs. Medicaid

Medicare is federal health insurance for people 65 and older and some younger people with disabilities or certain conditions, and income does not matter. Medicaid is run by each state for people with low incomes and limited resources. Medicare has premiums and the same rules everywhere; Medicaid usually costs nothing, varies by state, and covers nursing home care that Medicare normally does not.

Who Is Eligible for Both Medicare and Medicaid

People who qualify for Medicare, by age 65 or a disability, and who also meet their state’s Medicaid limits on income and savings can have both. About 13 million people do. Depending on income, Medicaid then pays their Medicare premiums, often their copays and deductibles, and care Medicare does not cover, like long-term care. People on Medicare are also exempt from the new Medicaid work requirement. KFF counts nearly one in five Medicare beneficiaries on both programs (KFF), and MACPAC describes the split: Medicare pays first for doctor and hospital care, and Medicaid wraps around it.

If you have Medicare and a low income, ask your state Medicaid office about both full Medicaid and the Medicare Savings Programs, which help with premiums for people whose income is a little too high for full coverage.

Does Medicaid Cover Dental?

Medicaid covers dental care for every child enrolled, in every state, as part of its required benefit for children. For adults, each state decides whether to cover dental care and how much, so the answer depends on where you live. Traditional Medicare does not cover most dental care either, so for seniors on both programs the state’s choice decides what is covered.

Federal law makes the children’s benefit mandatory as part of what Medicaid calls EPSDT, its checkup-and-treatment benefit for children, and every child is supposed to be referred to a dentist on the state’s schedule. The adult benefit is optional, so what adults get ranges widely from one state to the next (Medicaid.gov).

To find what your state covers, check your state Medicaid agency’s member handbook or call the number on your card. Because adult dental is optional, a state can also cut it, so check again after your state passes a budget.

If You Could Lose Medicaid

When Arkansas ran a work requirement, most people who lost coverage were still eligible, researchers found, so the steps below matter as much as the rules (Tradeoffs). Open the situation closest to yours.

Find your situation

Each gives the current rule and a next step. Rules as of September 25, 2026.

I got a notice that I have not met the work requirement

1. Under the CMS rule, you get 30 days from the notice to show 80 hours of work, volunteering, school or training in the month under review, or to show that an exemption applies.
2. If the notice says your coverage will end, ask for a fair hearing before that date. Coverage generally continues while the appeal is decided.
3. Free legal help: find your local legal aid office through the Legal Services Corporation.

My state is starting before January 2027

1. Nebraska began May 1, 2026, and Montana July 1, 2026. Iowa starts December 1, 2026. Arkansas began a soft launch July 1 but says it will not end anyone's coverage before January 1, 2027 (KFF, September 9, 2026).
2. In every other expansion state, the requirement starts January 1, 2027, unless CMS gives the state more time.
3. Find your state agency on Medicaid.gov and check which records it accepts before your renewal month.

I think I am exempt

1. You do not have to meet the requirement if you are under 19, pregnant or postpartum, enrolled in Medicare, a parent or caretaker of a child 13 or younger or of a disabled person, medically frail (including a disability, a substance use disorder or a disabling mental disorder), a former foster youth in that eligibility group, American Indian or Alaska Native, or out of jail or prison within the last 3 months.
2. An exemption usually has to be shown, not assumed. Answer any request for records, and keep copies.
3. How CMS defined "medically frail" is the main question in the states' lawsuit, so that definition could still change.

I am applying for Medicaid

1. Once your state starts, you may have to show 1 to 3 months of qualifying activity before the month you apply. Your state chooses how many.
2. The 2025 law also moves expansion adults to renewals every 6 months, so mark your renewal month and update your address.

I lost Medicaid during the pandemic unwinding

1. You can reapply at any time.
2. Apply through your state agency or at HealthCare.gov.

How Medicaid Is Funded

The federal government and the states split the bill, and the federal share is set by a formula called FMAP, short for Federal Medical Assistance Percentage. For traditional Medicaid, Washington covers between 50% and 83% of the cost, a higher share for states with lower per-person income.

The adults added by the Affordable Care Act are financed differently. Anyone earning up to 138% of the federal poverty level, $22,025 a year for one person in 2026, is matched at 90%, which leaves the state paying ten cents on the dollar.

Medicaid costs more per person than a basic insurance plan because it pays for care that private plans rarely cover. It covers 5 in 8 nursing home residents (KFF), the kind of long-term help that a commercial policy usually caps or excludes. A 1999 Supreme Court ruling, Olmstead v. L.C., requires states to offer that care in the community instead of an institution when that is appropriate, covered in disability rights law.

States raise their own share partly through provider taxes, which are levies on hospitals and nursing homes that the state then uses to draw down more federal money. Limits on those taxes are one of the largest sources of the 2025 law’s federal savings, KFF found in its review of CBO’s estimate (KFF).

Which States Expanded and Which Did Not

The Affordable Care Act let states open Medicaid in 2014 to every adult earning up to 138% of the federal poverty level, with the federal government paying 90% of the cost. Forty states and the District of Columbia took the deal. Ten refused, and they are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.

No state has expanded since North Carolina in December 2023.

Forty states and the District of Columbia expanded Medicaid. The ten holdouts cluster in the South.

Medicaid Expansion by State

• Expanded (legislative)
• Expanded (ballot measure)
• Not expanded
• Expanded (2014)

Source: KFF, Status of State Medicaid Expansion Decisions, updated August 21, 2026.

Medicaid Expansion by State

State	Expanded	Method	Status
Alabama	No	N/A	Not expanded. Coverage gap exists.
Alaska	2015	Legislative	Expanded
Arizona	2014	Legislative	Expanded
Arkansas	2014	Legislative	Expanded
California	2014	Legislative	Expanded
Colorado	2014	Legislative	Expanded
Connecticut	2014	Legislative	Expanded
Delaware	2014	Legislative	Expanded
District of Columbia	2014	Legislative	Expanded
Florida	No	N/A	Not expanded. Coverage gap exists.
Georgia	No	N/A	Not expanded. Coverage gap exists.
Hawaii	2014	Legislative	Expanded
Idaho	2020	Ballot measure	Expanded
Illinois	2014	Legislative	Expanded
Indiana	2015	Legislative	Expanded
Iowa	2014	Legislative	Expanded
Kansas	No	N/A	Not expanded. Coverage gap exists.
Kentucky	2014	Legislative	Expanded
Louisiana	2016	Legislative	Expanded
Maine	2019	Ballot measure	Expanded
Maryland	2014	Legislative	Expanded
Massachusetts	2014	Legislative	Expanded
Michigan	2014	Legislative	Expanded
Minnesota	2014	Legislative	Expanded
Mississippi	No	N/A	Not expanded. Coverage gap exists.
Missouri	2021	Ballot measure	Expanded
Montana	2016	Legislative	Expanded
Nebraska	2020	Ballot measure	Expanded
Nevada	2014	Legislative	Expanded
New Hampshire	2014	Legislative	Expanded
New Jersey	2014	Legislative	Expanded
New Mexico	2014	Legislative	Expanded
New York	2014	Legislative	Expanded
North Carolina	2023	Legislative	Expanded
North Dakota	2014	Legislative	Expanded
Ohio	2014	Legislative	Expanded
Oklahoma	2021	Ballot measure	Expanded
Oregon	2014	Legislative	Expanded
Pennsylvania	2015	Legislative	Expanded
Rhode Island	2014	Legislative	Expanded
South Carolina	No	N/A	Not expanded. Coverage gap exists.
South Dakota	2023	Ballot measure	Expanded
Tennessee	No	N/A	Not expanded. Coverage gap exists.
Texas	No	N/A	Not expanded. Coverage gap exists.
Utah	2020	Ballot measure	Expanded
Vermont	2014	Legislative	Expanded
Virginia	2019	Legislative	Expanded
Washington	2014	Legislative	Expanded
West Virginia	2014	Legislative	Expanded
Wisconsin	No	N/A	Not expanded. Coverage gap exists.
Wyoming	No	N/A	Not expanded. Coverage gap exists.

People in the ten non-expansion states are nearly twice as likely to be uninsured, KFF found.

Uninsured rate

Period	Value
Non-expansion states (2024)	14.5%
Expansion states (2024)	8.0%
Change	-6.5 pts

In most non-expansion states, an adult with no children has no Medicaid pathway at any income. In Texas, a parent in a family of three qualifies only below 15% of the poverty line, and an adult without children cannot qualify at all (Texas Medicaid).

That leaves 1.2 million adults in what researchers call the coverage gap, earning too much for their state’s Medicaid but too little for the subsidies that make marketplace plans affordable (KFF, July 2026, using 2024 data; KFF).

The measures researchers have tracked run worse in the ten states that did not expand.

Four states expanded since 2021, three of them by ballot measure: Missouri, Oklahoma and South Dakota.

Enrollment in the newest expansion states came quickly.

Those same ballot measures are now the target. Republican lawmakers in Missouri, Oklahoma, and South Dakota have moved to put expansion back before voters, and the South Dakota measure already approved for the November 2026 ballot would end expansion there if the federal match ever drops below 90% (Stateline).

What Expansion Changed for Infants and Rural Hospitals

Infant deaths moved in opposite directions after expansion. From 2014 to 2016, infant mortality in expansion states fell from 5.9 to 5.6 per 1,000 live births, while in non-expansion states it rose from 6.4 to 6.5 (American Journal of Public Health).

New mothers in Texas kept coverage only two months until 2024. Texas extended postpartum Medicaid and CHIP from 2 months to 12 months starting March 1, 2024 (Texas Medicaid).

Rural uninsured rates nearly halved where states expanded. In rural parts of expansion states, the uninsured rate fell from 16% to 9% between 2013 and 2015 (MACPAC). From 2010 to 2018, the states with the most rural hospital closures had not expanded: Texas lost 15 rural hospitals, Tennessee 9, and Georgia 7 (Georgetown CCF).

About half of rural hospitals run at a loss, and more than 10 million rural Americans rely on Medicaid.

The 300 estimate comes from researchers at the University of North Carolina’s Sheps Center, as reported by the American Osteopathic Association; the margin figure is from the American Hospital Association; the rural enrollment figure is from Chartis.

Congress Cut $911 Billion From Medicaid

President Trump signed the cut into law on July 4, 2025, and the rules have been landing ever since. CMS issued a binding rule in June 2026, while Nebraska began enforcing work rules on May 1, 2026 and cut the first people off that July. Twenty-six states sued to stop the rule in late June 2026 and lost their first bid to pause it a month later, so every remaining expansion state has to be running the requirement by January 1, 2027.

Every expansion state has to be enforcing work rules by January 1, 2027.

1. July 2025 Trump signs the $911 billion cut The One Big Beautiful Bill Act cuts federal Medicaid spending by $911 billion over ten years.
2. May 2026 Nebraska enforces work rules first Nebraska becomes the first state to apply the new requirement, months before the deadline.
3. June 3, 2026 CMS issues a binding work rule The interim final rule sets national terms and takes effect July 31, 2026.
4. June 2026 States sue over the rule Twenty-six states file in federal district court in Massachusetts and seek a pause.
5. July 30, 2026 Judge lets the work rule take effect Judge Richard Stearns denies the pause; the case continues on the merits.
6. Jan 2027 Work rules required in 40 states and DC Every expansion state must verify 80 hours a month for adults ages 19 to 64.

Sources: CMS; KFF Medicaid work requirements tracker; Stateline; Nebraska Public Media.

From signature to deadline, 2025 to 2027: July 2025: Trump signs the $911 billion cut (The One Big Beautiful Bill Act cuts federal Medicaid spending by $911 billion over ten years.). May 2026: Nebraska enforces work rules first (Nebraska becomes the first state to apply the new requirement, months before the deadline.). June 3, 2026: CMS issues a binding work rule (The interim final rule sets national terms and takes effect July 31, 2026.). June 2026: States sue over the rule (Twenty-six states file in federal district court in Massachusetts and seek a pause.). July 30, 2026: Judge lets the work rule take effect (Judge Richard Stearns denies the pause; the case continues on the merits.). Jan 2027: Work rules required in 40 states and DC (Every expansion state must verify 80 hours a month for adults ages 19 to 64.).

July 4, 2025: Trump signed the One Big Beautiful Bill Act, which reduces federal Medicaid spending by $911 billion over ten years. The Congressional Budget Office projects 10 million more people uninsured as a result, by KFF’s summary of CBO’s estimate (KFF). The same law’s new senior deduction lowers the tax on benefits that flows back to Social Security, one reason the 2026 Trustees gave for a worse outlook for the Social Security trust fund.

May 1, 2026: Nebraska became the first state to enforce the requirement, ahead of the federal deadline and before most states had built the systems to check hours.

June 3, 2026: CMS published an interim final rule that made the terms binding nationwide, effective July 31, 2026. The agency projects enrollment will fall by 2.3 million in fiscal 2027 and by 3.1 to 3.3 million a year after that.

Late June 2026: Twenty-six states, by STAT’s count, sued in federal district court in Massachusetts. They argued that the January deadline creates costly administrative hurdles and that the rule narrows who counts as medically frail (Healthcare Dive).

July 30, 2026: Judge Richard Stearns denied the states’ request to pause the rule. The states’ main harm was the tight timeline, he wrote, and “this timeline was set by Congress,” not by CMS (Healthcare Dive). He denied the pause without prejudice, so the case continues on the merits, and the states can ask again if it runs past January 1, 2027.

January 1, 2027: Every one of the 40 expansion states and the District of Columbia must be running the requirement, and so must Georgia, Tennessee and Wisconsin for adults covered through their waiver programs (KFF). A state that shows a good-faith effort can get more time, no later than December 31, 2028, and CMS says it expects to approve first requests for no longer than 6 months.

A proposed rule would cut more. CMS published a proposal on May 22, 2026 to cap the extra “state-directed payments” states make to hospitals and other providers through managed care. CMS estimates it would save $775 billion over 10 years, $510 billion of it federal, on top of the 2025 law (CMS). Public comments closed July 21, 2026.

Nursing homes lost a separate protection. CMS repealed the federal minimum-staffing standards for nursing homes, including the requirement for a registered nurse on site around the clock, in an interim final rule published December 3, 2025 (Federal Register).

How much people’s work changes when aid comes with no conditions at all is a separate question, compared study by study in the evidence on basic income.

Where the Work Requirement Stands

Four states moved before the federal deadline, and the national rule is in court. Each row carries its status as of September 25, 2026.

Where the Medicaid work requirement stands

As of September 25, 2026

• Federal requirement (2025 budget law) Law

  Required in every expansion state and DC by January 1, 2027, plus waiver programs in Georgia, Tennessee and Wisconsin.

• CMS interim final rule Agency action

  Published June 3, 2026 and in effect since July 31, 2026. (source)

• States' lawsuit (26 states, filed late June 2026) In litigation

  The judge refused to pause the rule on July 30, 2026. The case continues on the merits. (source)

• Nebraska Agency action, enforcing

  Began May 1, 2026. The first coverage losses came July 31, 2026.

• Montana Agency action, enforcing

  Began July 1, 2026.

• Iowa Agency action, starts Dec. 1

  Scheduled to begin December 1, 2026.

• Arkansas Agency action, soft launch

  Began July 1, 2026, with no coverage ended before January 1, 2027.

• Georgia Pathways Agency action, extended

  CMS extended the state's own work program through December 31, 2026, with reporting only at application and renewal. (source)

Source: Federal Register (2026-11094); KFF work requirements tracker (updated September 9, 2026); STAT; Nebraska Public Media; CMS

Nebraska’s first cutoffs landed on July 31, 2026. The state Medicaid director put the first group at roughly 200 people, and Nebraska Appleseed has estimated that up to 40,000 Nebraskans could eventually lose coverage.

Georgia has run its own work requirement, Pathways to Coverage, since 2023, and it stayed small. The governor’s office says more than 15,000 Georgians have benefited from it (Office of the Governor), and the Georgia Budget and Policy Institute found it has left the state’s uninsured rate for low-income adults largely unchanged (GBPI).

The law left the 90% expansion match itself untouched, and that is what keeps a set of state trigger laws dormant. Nine states would end expansion automatically or nearly automatically if that match ever falls: Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia.

Congress paired the cut with money for rural areas, the $50 billion Rural Health Transformation Program, which provides $10 billion a year to approved states for five fiscal years starting in 2026.

Who Loses Coverage and How

Arkansas ran the same reporting requirement in 2018. Adults ages 30 to 49 had to report 80 hours of work or other activity a month to keep coverage, and 18,164 people lost it, about one-third of everyone subject to the rule (Tradeoffs).

Employment did not rise. Benjamin Sommers and colleagues studied the first year in the New England Journal of Medicine and found no significant change in employment. More than 95% of the people targeted already met the requirement or should have been exempt, and one-third of those subject to it had not heard anything about it. A federal judge halted the program in March 2019.

A federal judge ended the Arkansas requirement. On March 27, 2019, Judge James Boasberg vacated the federal approval in Gresham v. Azar, ruling that the Department of Health and Human Services never addressed how many people would lose coverage (Georgetown CCF). A federal appeals court upheld that ruling in 2020 (AJMC). The 2025 law put the requirement in statute, so it no longer rests on a waiver a court can set aside the same way.

Adrian McGonigal was one of the people who lost coverage. The chicken plant worker logged his hours once and thought that was enough. Without his COPD medication he went to the emergency room, and Arkansas restored his Medicaid in January 2019. His breathing got worse, he lost the plant job, and he died of a heart attack in 2024 at 46. His Legal Aid attorney told Tradeoffs the work requirement “sent his life on a downward spiral that he never recovered from.”

Nebraska is where the same rule is landing now. Schmeeka Simpson has relied on Medicaid since 2014 and already lost SNAP benefits once when a technical error caused her to miss a renewal, and she fears the same paperwork will cost her health coverage. The same 2025 law expanded SNAP’s work requirements to adults up to 64 and to parents of teens.

Georgia shows what happens even when someone does everything right. Luke Seaborn appeared in a state promotional video for Pathways, logged his hours every month, and still had his benefits canceled twice by bureaucratic error. “I used to think of Pathways as a blessing,” he told ProPublica. “Now, I’m done with it.”

Paperwork is where many people lose coverage. During the unwinding of pandemic-era continuous coverage, more than 25 million people were disenrolled, 31% of completed renewals (KFF). In Kentucky, Beverly Likens lost Medicaid at the end of June 2023, which put her surgery for chronic uterine bleeding in doubt; she and an attorney who tried to help her blamed errors in the state’s eligibility system, and her coverage was reinstated in mid-July. In Florida, Indira Navas found that her 6-year-old son had been dropped while her 12-year-old daughter in the same household kept coverage.

Children lose coverage when their parents do, even when the rules exempt them. A Manatt analysis estimates 480,000 children would lose Medicaid if work requirements applied only to expansion adults, rising to 914,000 if they applied to all nondisabled adults.

In Wisconsin, Codie Peschl lost coverage she had held for 17 years. She is a home health caregiver earning $17.50 an hour, and her wage ran $433 a month too high for her own eligibility while staying low enough for her three children to keep theirs.

Common Misconceptions About Medicaid

Medicaid and Medicare are different programs. Medicare covers people 65 and older regardless of income, and Medicaid covers people with low incomes at any age. About 84% of Medicaid-covered nursing home residents were enrolled in both in 2019 (MACPAC).

Most adults on Medicaid work. 64% are employed and most of the rest are caregiving, ill, disabled, or in school, which leaves fewer than one in ten out of work for any other reason.

Expansion is reversible in nine states. Trigger laws there would end expansion automatically or nearly automatically if the 90% federal match drops.

Patients commit almost none of the fraud. Beneficiaries account for 2% of Medicaid fraud convictions and 0.1% of the money recovered; providers billing for care they never gave account for nearly all of it. The large “improper payment” totals are mostly paperwork: 79.5% of improper payments had missing or insufficient documentation or a technical error, not proof that the care should not have been paid (Georgetown CCF, citing state Medicaid Fraud Control Unit and CMS data).

The Honest Disagreement

Serious people disagree about how Medicaid should be financed, and the argument is narrower than the headlines suggest. It turns on two things, the 90% federal match for expansion adults and the way states raise their own share.

The case for cutting comes from the Paragon Health Institute and its president Brian Blase, a former White House health policy adviser. They argue that a 90% match pays states more to cover working-age adults than to cover children and people with disabilities, and that provider taxes let a state manufacture its share rather than fund it.

The case against those cuts comes from KFF, the Center on Budget and Policy Priorities, and most state Medicaid directors. They argue that provider taxes are a legal financing tool CMS has approved for four decades, that enrollment tracks real need in a country where employer coverage keeps shrinking, and that removing federal dollars removes neither the patients nor the cost of treating them.

Both sides agree the program is expensive: total spending reached $900.3 billion in fiscal 2023 (MACPAC). Where they split is whether the fix is less federal money or more.

We do not call a winner on the financing question. The record on work requirements is thinner and more one-sided, because Arkansas is the only state that has run one at scale and employment there did not rise.

Frequently Asked Questions

What is the difference between Medicare and Medicaid?

Medicare is federal health insurance for people 65 and older and some younger people with disabilities or certain conditions, and income does not matter. Medicaid is run by each state for people with low incomes and limited resources. Medicare has premiums and the same rules everywhere; Medicaid usually costs nothing, varies by state, and covers nursing home care that Medicare normally does not.

How do I qualify for Medicaid?

You qualify for Medicaid through your income and who you are. Children, pregnant women, and people on Supplemental Security Income qualify in every state. In the 40 states and D.C. that expanded, any adult under 65 with income up to 138% of the poverty level qualifies, which is $22,025 a year for one person in 2026. Apply through your state Medicaid agency or HealthCare.gov.

Does Medicaid cover dental?

Medicaid covers dental care for every child enrolled, in every state, as part of its required benefit for children. For adults, each state decides whether to cover dental care and how much, so the answer depends on where you live. Traditional Medicare does not cover most dental care either, so for seniors on both programs the state’s choice decides what is covered.

Can I have Medicaid and Medicare at the same time?

People who qualify for Medicare, by age 65 or a disability, and who also meet their state’s Medicaid limits on income and savings can have both. About 13 million people do. Depending on income, Medicaid then pays their Medicare premiums, often their copays and deductibles, and care Medicare does not cover, like long-term care. People on Medicare are also exempt from the new Medicaid work requirement.

Will I lose my Medicaid?

It depends on your state and your eligibility category. Children, pregnant women, and people with disabilities are not subject to work requirements. If you are an adult covered through expansion, you will need to document 80 hours a month starting January 1, 2027, or earlier if your state moved first.

What counts toward the Medicaid work requirement's 80 hours?

Paid work, self-employment, community service, job training, and school all count, and states may combine them across a month. Your state decides which records it will accept, so check its Medicaid site before your renewal date rather than after.

Do work requirements apply to everyone on Medicaid?

No. Exemptions cover pregnant women, people with disabilities, people in substance use treatment, and caretakers, among others. The reporting still reaches broadly, though, because an exemption usually has to be proved rather than assumed.

How much can I earn and still get Medicaid?

In a state that expanded Medicaid, adults qualify with income up to 138% of the federal poverty level. For 2026 that is $22,025 a year for one person, $29,863 for two, $37,702 for three, and $45,540 for four, with higher limits in Alaska and Hawaii. Children and pregnant women qualify at higher incomes in every state. In the 10 states that did not expand, most adults without children cannot qualify at any income. The limits come from the HHS poverty guidelines, and your state’s Medicaid site lists its exact numbers.

What can I do if I am cut off Medicaid by mistake?

Ask for a fair hearing. Every state has to offer an appeal, and if you file before the date your notice says coverage ends, your state generally has to keep the coverage running while the appeal is decided. Legal aid offices handle these cases free.

What about people who lost Medicaid during the COVID unwinding?

More than 25 million people were disenrolled when pandemic-era continuous coverage ended. If you were dropped, you can reapply at any time through your state Medicaid office or healthcare.gov.

Do undocumented immigrants get Medicaid?

Not full Medicaid. Federal law bars federal Medicaid payment for undocumented immigrants except for emergency care. Starting October 1, 2026, the federal government pays for that emergency care at each state’s regular match rate instead of the higher expansion rate (2025 budget law, Sec. 71110).

What You Can Do

1. Ask your governor whether your state is moving before January 2027. Nebraska, Montana, Arkansas, and Iowa went early. If yours is one of them, ask what it has built so that working people are not dropped the way 18,164 Arkansans were in 2018, and ask for the answer in writing.

2. Ask both senators to restore the $911 billion. The cut runs through provider tax limits, eligibility checks, and the work requirement, and each piece can be reversed separately. Ask which of the three they will vote to repeal.

3. Update your address and check your reporting date now if you are on expansion Medicaid. In Arkansas, most people who lost coverage were still eligible, researchers found. Your state Medicaid office can confirm your renewal month and what it will accept as proof of hours.

4. Show up at your state budget hearings. State legislators decide which services absorb the federal reduction. Public comment periods on those decisions are usually posted by the state Medicaid agency.

5. Write your representative using the letter below, and ask for a clear answer on whether they will vote to delay the January 2027 deadline until states can verify hours without dropping people who are working.